/*jslint nomen:false, debug:true, evil:true, vars:false, browser:true, forin:true, undef:false, white:false */
/**
* Includes a Form with javascript
* @param {Object} formId
* @param {Object} initialHeight
* @param {Object} iframeCode
*/
function FrameBuilder (formId, appendTo, initialHeight, iframeCode){
this.formId = formId;
this.initialHeight = initialHeight;
this.iframeCode = iframeCode;
this.frame = null;
this.timeInterval= 200;
this.appendTo = appendTo || false;
// initialize function for object
this.init = function(){
this.createFrame();
this.addFrameContent(this.iframeCode);
};
// Create the frame
this.createFrame = function(){
var htmlCode = "<"+"iframe src=\"\" allowtransparency=\"true\" frameborder=\"0\" name=\""+this.formId+"\" id=\""+this.formId+"\" style=\"width:100%; height:"+this.initialHeight+"px; border:none;\" scrolling=\"no\">";
if(this.appendTo === false){
document.write(htmlCode);
}else{
var tmp = document.createElement('div');
tmp.innerHTML = htmlCode;
var a = this.appendTo;
document.getElementById(a).appendChild(tmp.firstChild);
}
// also get the frame for future use.
this.frame = document.getElementById(this.formId);
// set the time on the on load event of the frame
this.addEvent(this.frame, 'load', this.bindMethod(this.setTimer, this));
};
// add event function for different browsers
this.addEvent = function( obj, type, fn ) {
if ( obj.attachEvent ) {
obj["e"+type+fn] = fn;
obj[type+fn] = function() { obj["e"+type+fn]( window.event ); };
obj.attachEvent( "on"+type, obj[type+fn] );
}
else{
obj.addEventListener( type, fn, false );
}
};
this.addFrameContent = function (string){
string = string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>', 'gim'), 'src="http://api.recaptcha.net/js/recaptcha_ajax.js"><'+'div id="recaptcha_div"><'+'/div>'+
'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+
'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+
'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+
' }<'+'/script>');
string = string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/, '$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');
var frameDocument = (this.frame.contentWindow) ? this.frame.contentWindow : (this.frame.contentDocument.document) ? this.frame.contentDocument.document : this.frame.contentDocument;
frameDocument.document.open();
frameDocument.document.write(string);
setTimeout( function(){
frameDocument.document.close();
try{
if('JotFormFrameLoaded' in window){
JotFormFrameLoaded();
}
}catch(e){}
},200);
};
this.setTimer = function(){
var self = this;
this.interval = setTimeout(function(){self.changeHeight();},this.timeInterval);
};
this.changeHeight = function (){
var actualHeight = this.getBodyHeight();
var currentHeight = this.getViewPortHeight();
if(actualHeight === undefined){
this.frame.style.height = "100%";
if(!this.frame.style.minHeight){
this.frame.style.minHeight = "300px";
}
}else if (Math.abs(actualHeight - currentHeight) > 18){
this.frame.style.height = (actualHeight)+"px";
}
this.setTimer();
};
this.bindMethod = function(method, scope) {
return function() {
method.apply(scope,arguments);
};
};
this.getBodyHeight = function (){
var height;
var scrollHeight;
var offsetHeight;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.document.height){
height = this.frame.contentWindow.document.height;
//Emre: to prevent "iframe height" problem (61059)
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
} else if (this.frame.contentWindow.document.body){
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
if (scrollHeight && offsetHeight){
height = Math.max(scrollHeight, offsetHeight);
}
}
}catch(e){ }
return height;
};
this.getViewPortHeight = function(){
var height = 0;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.window.innerHeight)
{
height = this.frame.contentWindow.window.innerHeight - 18;
}
else if ((this.frame.contentWindow.document.documentElement) &&
(this.frame.contentWindow.document.documentElement.clientHeight))
{
height = this.frame.contentWindow.document.documentElement.clientHeight;
}
else if ((this.frame.contentWindow.document.body) &&
(this.frame.contentWindow.document.body.clientHeight))
{
height = this.frame.contentWindow.document.body.clientHeight;
}
}catch(e){ }
return height;
};
this.init();
}
FrameBuilder.get = [];
var i93555836166 = new FrameBuilder("93555836166", false, "", "\n\n\n\n\nForm<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2435\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"http:\/\/www.jotform.com\/css\/styles\/baby_blue.css\" \/>\n<style type=\"text\/css\">\n .form-label{\n width:150px !important;\n }\n .form-label-left{\n width:150px !important;\n }\n .form-line{\n padding:5px;\n }\n .form-label-right{\n width:150px !important;\n }\n body, html{\n margin:0;\n padding:0;\n background:#D7E9F3;\n }\n\n .form-all{\n margin:0px auto;\n padding-top:0px;\n width:690px;\n background:#D7E9F3;\n color:#394F5F !important;\n font-family:Arial;\n font-size:14px;\n }\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/min\/g=jotform?3.0.2435\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n JotForm.jsForm = true;\n\n JotForm.init(function(){\n JotForm.description('input_24', 'Please Select');\n JotForm.description('input_28', 'If access to intend is dirt, gravel, sand please give details');\n });\n\n clearInterval(jsTime);\n }catch(e){}}, 1000);\n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"http:\/\/submit.jotform.com\/submit.php\" method=\"post\" name=\"form_93555836166\" id=\"93555836166\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"93555836166\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li id=\"cid_71\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_71\" class=\"form-header\">\n GOLD COAST TWEED CAMPER & CARAVAN HIRE\n <\/h2>\n <\/div>\n <\/li>\n <li id=\"cid_8\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_8\" class=\"form-header\">\n Booking Enquiry Form\n <\/h2>\n <\/div>\n <\/li>\n <li id=\"cid_57\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_57\" class=\"form-header\">\n Your details\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_9\">\n <label class=\"form-label-left\" id=\"label_9\" for=\"input_9\">\n First Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_9\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Alphabetic]\" id=\"input_9\" name=\"q9_firstName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_10\">\n <label class=\"form-label-left\" id=\"label_10\" for=\"input_10\">\n Last Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_10\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Alphabetic]\" id=\"input_10\" name=\"q10_lastName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_11\">\n <label class=\"form-label-left\" id=\"label_11\" for=\"input_11\">\n Your Email Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_11\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Email]\" id=\"input_11\" name=\"q11_yourEmail\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_77\">\n <label class=\"form-label-left\" id=\"label_77\" for=\"input_77\">\n Best Contact Phone Number<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_77\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_77\" name=\"q77_bestContact\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_12\">\n <label class=\"form-label-left\" id=\"label_12\" for=\"input_12\"> Street Number <\/label>\n <div id=\"cid_12\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_12\" name=\"q12_streetNumber\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_13\">\n <label class=\"form-label-left\" id=\"label_13\" for=\"input_13\"> Address <\/label>\n <div id=\"cid_13\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_13\" name=\"q13_address\" size=\"20\" maxlength=\"200\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_14\">\n <label class=\"form-label-left\" id=\"label_14\" for=\"input_14\"> Town <\/label>\n <div id=\"cid_14\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_14\" name=\"q14_town\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_15\">\n <label class=\"form-label-left\" id=\"label_15\" for=\"input_15\"> State <\/label>\n <div id=\"cid_15\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_15\" name=\"q15_state\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_16\">\n <label class=\"form-label-left\" id=\"label_16\" for=\"input_16\">\n Postcode<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_16\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_16\" name=\"q16_postcode\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_31\">\n <label class=\"form-label-left\" id=\"label_31\" for=\"input_31\"> Postal Address if different <\/label>\n <div id=\"cid_31\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_31\" name=\"q31_postalAddress\" size=\"20\" maxlength=\"400\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_17\">\n <label class=\"form-label-left\" id=\"label_17\" for=\"input_17\"> Home Phone <\/label>\n <div id=\"cid_17\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[Numeric]\" id=\"input_17\" name=\"q17_homePhone\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_18\">\n <label class=\"form-label-left\" id=\"label_18\" for=\"input_18\"> Work Phone <\/label>\n <div id=\"cid_18\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[Numeric]\" id=\"input_18\" name=\"q18_workPhone\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_19\">\n <label class=\"form-label-left\" id=\"label_19\" for=\"input_19\"> Mobile Phone.... <\/label>\n <div id=\"cid_19\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[Numeric]\" id=\"input_19\" name=\"q19_mobilePhone\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_58\">\n <label class=\"form-label-left\" id=\"label_58\" for=\"input_58\"> Are you under 25 years or over 75 years of age <\/label>\n <div id=\"cid_58\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_58_0\" name=\"q58_areYou[]\" value=\"Yes\" \/>\n <label for=\"input_58_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_58_1\" name=\"q58_areYou[]\" value=\"No\" \/>\n <label for=\"input_58_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_69\">\n <label class=\"form-label-left\" id=\"label_69\" for=\"input_69\"> If answered yes please show your year of birth <\/label>\n <div id=\"cid_69\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_69\" name=\"q69_ifAnswered\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_24\">\n <label class=\"form-label-left\" id=\"label_24\" for=\"input_24\">\n Please Select<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_24\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_0\" name=\"q24_pleaseSelect[]\" value=\"Jayco Eagle Camper Trailer\" \/>\n <label for=\"input_24_0\"> Jayco Eagle Camper Trailer <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_1\" name=\"q24_pleaseSelect[]\" value=\"Jayco Swan Camper Trailer\" \/>\n <label for=\"input_24_1\"> Jayco Swan Camper Trailer <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_2\" name=\"q24_pleaseSelect[]\" value=\"Jayco 1652.8 Pop-top Caravan\" \/>\n <label for=\"input_24_2\"> Jayco 1652.8 Pop-top Caravan <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_3\" name=\"q24_pleaseSelect[]\" value=\"Jayco 1755.5 Pop-top Caravan\" \/>\n <label for=\"input_24_3\"> Jayco 1755.5 Pop-top Caravan <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_4\" name=\"q24_pleaseSelect[]\" value=\"Oztent Rv3\" \/>\n <label for=\"input_24_4\"> Oztent Rv3 <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_5\" name=\"q24_pleaseSelect[]\" value=\"Oztent Rv4\" \/>\n <label for=\"input_24_5\"> Oztent Rv4 <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_6\" name=\"q24_pleaseSelect[]\" value=\"Oztent High side wall set\" \/>\n <label for=\"input_24_6\"> Oztent High side wall set <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_7\" name=\"q24_pleaseSelect[]\" value=\"Engel 40 lt Fridge\" \/>\n <label for=\"input_24_7\"> Engel 40 lt Fridge <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_8\" name=\"q24_pleaseSelect[]\" value=\"Engel Two Zone Lid\" \/>\n <label for=\"input_24_8\"> Engel Two Zone Lid <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_9\" name=\"q24_pleaseSelect[]\" value=\"Waeco CF40 Fridge\" \/>\n <label for=\"input_24_9\"> Waeco CF40 Fridge <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_10\" name=\"q24_pleaseSelect[]\" value=\"Waeco CF 60 Fridge\" \/>\n <label for=\"input_24_10\"> Waeco CF 60 Fridge <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_11\" name=\"q24_pleaseSelect[]\" value=\"Waeco Raps36 Battery Pack\" \/>\n <label for=\"input_24_11\"> Waeco Raps36 Battery Pack <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_12\" name=\"q24_pleaseSelect[]\" value=\"Annex Walls\" \/>\n <label for=\"input_24_12\"> Annex Walls <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_13\" name=\"q24_pleaseSelect[]\" value=\"Annex Flooring\" \/>\n <label for=\"input_24_13\"> Annex Flooring <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_14\" name=\"q24_pleaseSelect[]\" value=\"Shade Wall\" \/>\n <label for=\"input_24_14\"> Shade Wall <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_15\" name=\"q24_pleaseSelect[]\" value=\"Honda EU20i Generator\" \/>\n <label for=\"input_24_15\"> Honda EU20i Generator <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_16\" name=\"q24_pleaseSelect[]\" value=\"Bike Rack\" \/>\n <label for=\"input_24_16\"> Bike Rack <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_17\" name=\"q24_pleaseSelect[]\" value=\"Porta Potti Toilet\" \/>\n <label for=\"input_24_17\"> Porta Potti Toilet <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_18\" name=\"q24_pleaseSelect[]\" value=\"Solar Panel Folding Portable 90 Watt\" \/>\n <label for=\"input_24_18\"> Solar Panel Folding Portable 90 Watt <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_19\" name=\"q24_pleaseSelect[]\" value=\"Other\" \/>\n <label for=\"input_24_19\"> Other <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_60\">\n <label class=\"form-label-left\" id=\"label_60\" for=\"input_60\"> Number of Adults <\/label>\n <div id=\"cid_60\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_60\" name=\"q60_numberOf\">\n <option> <\/option>\n <option value=\"0\"> 0 <\/option>\n <option value=\"1\"> 1 <\/option>\n <option value=\"2\"> 2 <\/option>\n <option value=\"3\"> 3 <\/option>\n <option value=\"4\"> 4 <\/option>\n <option value=\"5\"> 5 <\/option>\n <option value=\"6\"> 6 <\/option>\n <option value=\"7\"> 7 <\/option>\n <option value=\"8\"> 8 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_61\">\n <label class=\"form-label-left\" id=\"label_61\" for=\"input_61\"> Number of Children <\/label>\n <div id=\"cid_61\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_61\" name=\"q61_numberOf61\">\n <option> <\/option>\n <option value=\"0\"> 0 <\/option>\n <option value=\"1\"> 1 <\/option>\n <option value=\"2\"> 2 <\/option>\n <option value=\"3\"> 3 <\/option>\n <option value=\"4\"> 4 <\/option>\n <option value=\"5\"> 5 <\/option>\n <option value=\"6\"> 6 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_53\">\n <label class=\"form-label-left\" id=\"label_53\" for=\"input_53\"> Ages of Children eg (2,5,9) <\/label>\n <div id=\"cid_53\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_53\" name=\"q53_agesOf\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_49\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_49\" class=\"form-header\">\n Dates & Times\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_72\">\n <label class=\"form-label-left\" id=\"label_72\" for=\"input_72\"> Date required: DD\/MM\/YYYY) <\/label>\n <div id=\"cid_72\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_72\" name=\"q72_dateRequired\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_36\">\n <label class=\"form-label-left\" id=\"label_36\" for=\"input_36\"> Pick up or Delivery Time (NSW Time) <\/label>\n <div id=\"cid_36\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_36\" name=\"q36_pickUp\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_73\">\n <label class=\"form-label-left\" id=\"label_73\" for=\"input_73\"> Date of Return: DD\/MM\/YYYY <\/label>\n <div id=\"cid_73\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_73\" name=\"q73_dateOf\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_37\">\n <label class=\"form-label-left\" id=\"label_37\" for=\"input_37\"> Return Time (NSW Time) <\/label>\n <div id=\"cid_37\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_37\" name=\"q37_returnTime\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_23\">\n <label class=\"form-label-left\" id=\"label_23\" for=\"input_23\"> Date options <\/label>\n <div id=\"cid_23\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_23_0\" name=\"q23_dateOptions[]\" value=\"No Flexibilty\" \/>\n <label for=\"input_23_0\"> No Flexibilty <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_23_1\" name=\"q23_dateOptions[]\" value=\"Within 1 day either side of requested dates\" \/>\n <label for=\"input_23_1\"> Within 1 day either side of requested dates <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_23_2\" name=\"q23_dateOptions[]\" value=\"Within 2 - 3 days of requested dates\" \/>\n <label for=\"input_23_2\"> Within 2 - 3 days of requested dates <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_23_3\" name=\"q23_dateOptions[]\" value=\"Within 7 days of requested dates\" \/>\n <label for=\"input_23_3\"> Within 7 days of requested dates <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_41\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_41\" class=\"form-header\">\n For Touring Hire, where will you be towing the Caravan or Camper Trailer\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_26\">\n <label class=\"form-label-left\" id=\"label_26\" for=\"input_26\"> Brief Itinerary of Trip <\/label>\n <div id=\"cid_26\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_26\" name=\"q26_briefItinerary\" size=\"20\" maxlength=\"600\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_64\">\n <label class=\"form-label-left\" id=\"label_64\" for=\"input_64\"> Will you be towing on any unsealed road (Dirt, Sand, Gravel) <\/label>\n <div id=\"cid_64\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_64_0\" name=\"q64_willYou[]\" value=\"Yes\" \/>\n <label for=\"input_64_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_64_1\" name=\"q64_willYou[]\" value=\"No\" \/>\n <label for=\"input_64_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_63\">\n <label class=\"form-label-left\" id=\"label_63\" for=\"input_63\"> If answered yes please give details <\/label>\n <div id=\"cid_63\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_63\" name=\"q63_ifAnswered63\" size=\"20\" maxlength=\"400\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_70\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_70\" class=\"form-header\">\n Your Towing Vehicle Details\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_38\">\n <label class=\"form-label-left\" id=\"label_38\" for=\"input_38\"> Make of Towing Vehicle <\/label>\n <div id=\"cid_38\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_38\" name=\"q38_makeOf\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_39\">\n <label class=\"form-label-left\" id=\"label_39\" for=\"input_39\"> Model & Year <\/label>\n <div id=\"cid_39\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_39\" name=\"q39_modelamp\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_40\">\n <label class=\"form-label-left\" id=\"label_40\" for=\"input_40\"> Engine & Gearbox <\/label>\n <div id=\"cid_40\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_40_0\" name=\"q40_engineamp[]\" value=\"Petrol\" \/>\n <label for=\"input_40_0\"> Petrol <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_40_1\" name=\"q40_engineamp[]\" value=\"LPG\" \/>\n <label for=\"input_40_1\"> LPG <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_40_2\" name=\"q40_engineamp[]\" value=\"Diesel\" \/>\n <label for=\"input_40_2\"> Diesel <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_40_3\" name=\"q40_engineamp[]\" value=\"Turbo\" \/>\n <label for=\"input_40_3\"> Turbo <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_40_4\" name=\"q40_engineamp[]\" value=\"Automatic\" \/>\n <label for=\"input_40_4\"> Automatic <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_40_5\" name=\"q40_engineamp[]\" value=\"Manual\" \/>\n <label for=\"input_40_5\"> Manual <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_56\">\n <label class=\"form-label-left\" id=\"label_56\" for=\"input_56\"> Does your vehicle have fully Comprehensive Insurance Cover <\/label>\n <div id=\"cid_56\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_56_0\" name=\"q56_doesYour[]\" value=\"Yes\" \/>\n <label for=\"input_56_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_56_1\" name=\"q56_doesYour[]\" value=\"No\" \/>\n <label for=\"input_56_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_54\">\n <label class=\"form-label-left\" id=\"label_54\" for=\"input_54\"> Electric Brake Controller <\/label>\n <div id=\"cid_54\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_54_0\" name=\"q54_electricBrake[]\" value=\"Fitted in Towing Vehicle\" \/>\n <label for=\"input_54_0\"> Fitted in Towing Vehicle <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_54_1\" name=\"q54_electricBrake[]\" value=\"Free Loan of Portable Brake Control Unit Required\" \/>\n <label for=\"input_54_1\"> Free Loan of Portable Brake Control Unit Required <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_54_2\" name=\"q54_electricBrake[]\" value=\"Unsure\" \/>\n <label for=\"input_54_2\"> Unsure <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_67\">\n <label class=\"form-label-left\" id=\"label_67\" for=\"input_67\"> Your Towball Height (measured from top of towball to the ground in cms) <\/label>\n <div id=\"cid_67\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_67\" name=\"q67_yourTowball\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_65\">\n <label class=\"form-label-left\" id=\"label_65\" for=\"input_65\"> Your Towing Vehicles Trailer Socket (we recommend that you have the 7 Pin Flat Type) <\/label>\n <div id=\"cid_65\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_65_0\" name=\"q65_yourTowing65[]\" value=\"7 Pin Flat\" \/>\n <label for=\"input_65_0\"> 7 Pin Flat <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_65_1\" name=\"q65_yourTowing65[]\" value=\"7 pin Round Small\" \/>\n <label for=\"input_65_1\"> 7 pin Round Small <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_65_2\" name=\"q65_yourTowing65[]\" value=\"7 pin Round Large\" \/>\n <label for=\"input_65_2\"> 7 pin Round Large <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_65_3\" name=\"q65_yourTowing65[]\" value=\"In good working order\" \/>\n <label for=\"input_65_3\"> In good working order <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_65_4\" name=\"q65_yourTowing65[]\" value=\"50 Amp Anderson plug fitted (optional)\" \/>\n <label for=\"input_65_4\"> 50 Amp Anderson plug fitted (optional) <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_42\">\n <label class=\"form-label-left\" id=\"label_42\" for=\"input_42\"> Has the towing vehicle being lowered or raised <\/label>\n <div id=\"cid_42\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_42_0\" name=\"q42_hasThe[]\" value=\"Yes\" \/>\n <label for=\"input_42_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_42_1\" name=\"q42_hasThe[]\" value=\"No\" \/>\n <label for=\"input_42_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_43\">\n <label class=\"form-label-left\" id=\"label_43\" for=\"input_43\"> Towbar Capacity in Kgs <\/label>\n <div id=\"cid_43\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_43\" name=\"q43_towbarCapacity\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_44\">\n <label class=\"form-label-left\" id=\"label_44\" for=\"input_44\"> Tow Bar Download Kgs <\/label>\n <div id=\"cid_44\" class=\"form-input\">\n <textarea id=\"input_44\" class=\"form-textarea\" name=\"q44_towBar\" cols=\"30\" rows=\"1\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_47\">\n <label class=\"form-label-left\" id=\"label_47\" for=\"input_47\"> Touring Hire Excess <\/label>\n <div id=\"cid_47\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_47_0\" name=\"q47_touringHire[]\" value=\"Standard Touring Hire Excess $2750.00 per incident\" \/>\n <label for=\"input_47_0\"> Standard Touring Hire Excess $2750.00 per incident <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_47_1\" name=\"q47_touringHire[]\" value=\"Optional Touring Hire Excess Reduction $12.00 per day. Excess is reduced to $600.00 per incident\" \/>\n <label for=\"input_47_1\"> Optional Touring Hire Excess Reduction $12.00 per day. Excess is reduced to $600.00 per incident <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_48\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_48\" class=\"form-header\">\n On Onsite Hire (where we tow & deliver for you)\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_25\">\n <label class=\"form-label-left\" id=\"label_25\" for=\"input_25\"> Address of site <\/label>\n <div id=\"cid_25\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_25\" name=\"q25_addressOf\" size=\"20\" maxlength=\"250\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_46\">\n <label class=\"form-label-left\" id=\"label_46\" for=\"input_46\"> Any other information <\/label>\n <div id=\"cid_46\" class=\"form-input\">\n <textarea id=\"input_46\" class=\"form-textarea\" name=\"q46_anyOther\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_28\">\n <label class=\"form-label-left\" id=\"label_28\" for=\"input_28\"> Are all access roads sealed if not please give details <\/label>\n <div id=\"cid_28\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_28\" name=\"q28_areAll\" size=\"20\" maxlength=\"250\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_27\">\n <label class=\"form-label-left\" id=\"label_27\" for=\"input_27\"> Delivery & setup options <\/label>\n <div id=\"cid_27\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_27_0\" name=\"q27_deliveryamp[]\" value=\"Delivery - Setup - Pack up Required\" \/>\n <label for=\"input_27_0\"> Delivery - Setup - Pack up Required <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_27_1\" name=\"q27_deliveryamp[]\" value=\"In Caravan Park\" \/>\n <label for=\"input_27_1\"> In Caravan Park <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_27_2\" name=\"q27_deliveryamp[]\" value=\"At a home or on Private land\" \/>\n <label for=\"input_27_2\"> At a home or on Private land <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_62\">\n <label class=\"form-label-left\" id=\"label_62\" for=\"input_62\"> Does the site have <\/label>\n <div id=\"cid_62\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_62_0\" name=\"q62_doesThe[]\" value=\"Power 10 Amp Outlet\" \/>\n <label for=\"input_62_0\"> Power 10 Amp Outlet <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_62_1\" name=\"q62_doesThe[]\" value=\"Power 15 Amp Outlet\" \/>\n <label for=\"input_62_1\"> Power 15 Amp Outlet <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_62_2\" name=\"q62_doesThe[]\" value=\"Water Tap\" \/>\n <label for=\"input_62_2\"> Water Tap <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_45\">\n <label class=\"form-label-left\" id=\"label_45\" for=\"input_45\"> Best way to contact you <\/label>\n <div id=\"cid_45\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_45_0\" name=\"q45_bestWay[]\" value=\"Email\" \/>\n <label for=\"input_45_0\"> Email <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_45_1\" name=\"q45_bestWay[]\" value=\"Phone\" \/>\n <label for=\"input_45_1\"> Phone <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_45_2\" name=\"q45_bestWay[]\" value=\"AM\" \/>\n <label for=\"input_45_2\"> AM <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_45_3\" name=\"q45_bestWay[]\" value=\"PM\" \/>\n <label for=\"input_45_3\"> PM <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_45_4\" name=\"q45_bestWay[]\" value=\"Evening\" \/>\n <label for=\"input_45_4\"> Evening <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_68\">\n <label class=\"form-label-left\" id=\"label_68\" for=\"input_68\"> Best phone number to contact you on <\/label>\n <div id=\"cid_68\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_68\" name=\"q68_bestPhone\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_50\">\n <label class=\"form-label-left\" id=\"label_50\" for=\"input_50\">\n I agree to the terms & conditions of hire<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_50\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_50_0\" name=\"q50_iAgree[]\" value=\"Yes\" \/>\n <label for=\"input_50_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_50_1\" name=\"q50_iAgree[]\" value=\"No\" \/>\n <label for=\"input_50_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_79\">\n <label class=\"form-label-left\" id=\"label_79\" for=\"input_79\"> Your Message.... <\/label>\n <div id=\"cid_79\" class=\"form-input\">\n <textarea id=\"input_79\" class=\"form-textarea\" name=\"q79_yourMessage\" cols=\"30\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_1\">\n <div id=\"cid_1\" class=\"form-input-wide\">\n <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n <button id=\"input_1\" type=\"submit\" class=\"form-submit-button\">\n Submit\n <\/button>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_75\">\n <div id=\"cid_75\" class=\"form-input-wide\">\n <div id=\"text_75\" class=\"form-html\">\n After Submit is clicked a receipt message should appear on your screen. Please phone us if you dont receive the receipt as we have not received your booking enquiry 0409 309 880 or 07 5513 0950\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_66\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_66\" class=\"form-header\">\n Copyright \u00a9 2007 - 2010 Gold Coast Tweed Camper & Caravan Hire\n <\/h2>\n <\/div>\n <\/li>\n <li style=\"display:none\">\n Should be Empty:\n <input type=\"text\" name=\"website\" value=\"\" \/>\n <\/li>\n <\/ul>\n <\/div>\n <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"93555836166\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"93555836166-93555836166\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");